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STATE OF RHODE ISLAND DEPARTMENT OF BUSINESS REGULATION SECURITIES DIVISION JOHN O. PASTOR COMPLEX BUILDING 691 CRANSTON, RI 02920 401.4629527 (PHONE) 401.4629645 (FAX)Office Use Only Case No. ___

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Obtain the RI Department of Health form.

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Anyone residing in Rhode Island who needs to report their health information or medical history to the Department of Health.

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Healthcare professionals who are required to submit certain health-related documentation to the Department of Health.

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The Rhode Island Department of Health is a state agency responsible for protecting and promoting the health and safety of the residents of Rhode Island.

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Certain healthcare facilities, providers, and organizations are required to file reports with the Rhode Island Department of Health.

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The purpose of the Rhode Island Department of Health is to monitor and improve public health, prevent disease outbreaks, and ensure healthcare facilities comply with regulations.

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Information such as patient demographics, disease outbreaks, vaccination rates, and healthcare facility inspections must be reported to the Rhode Island Department of Health.

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